Healthcare Provider Details

I. General information

NPI: 1598372963
Provider Name (Legal Business Name): ALLIANCE SURGERY CENTER AT PEACHTREE CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 HIGHWAY 54 W STE 105
PEACHTREE CITY GA
30269-4794
US

IV. Provider business mailing address

3390 PEACHTREE RD NE STE 1500
ATLANTA GA
30326-2822
US

V. Phone/Fax

Practice location:
  • Phone: 404-920-4950
  • Fax:
Mailing address:
  • Phone: 404-920-4950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA BECK
Title or Position: CFO
Credential:
Phone: 404-920-4950